Young adult, graduate student, semi-vagabond and Type 1 diabetic

Tag Archives: Kenya

Gender is a very interesting construct in Kenya. In my opinion, women here are generally stronger than the men, upholding children and family lives with or without a present father/husband figure. They find ways of providing food, shelter, and school fees, while not having the same vocational opportunities as their male counterparts. This isn’t to say that all Kenyan men are weak, but the emphasis of their time and roles is very different from women’s roles. Several days ago I was meeting with two businessmen who have become friends, one in his early thirties, the other in his late thirties. The older man, Steve, is married with children, but was in the process of seeking out an mpango wa kando (girlfriend). Polygamous tradition seems to have led to this “modern” mpango wa kando cultural norm, of married men taking girlfriends, wooing them through the exchange of money and gifts. In fact, newspaper reports lead me to believe that many university female students will look for an older successful business man to help them with school fees (while girls in the village look for boyfriends/will exchange sex to boys for the local snack mandazis or some texting credit).

I’m slightly fascinated with sexuality and the implementation of sex as a commodity in this area, so of course, I proceeded to grill Steve about his desire for a girlfriend, his motivations, and his rationality on why it was acceptable. Steve has a “girlfriend” he is currently wooing–he has told her he has a wife, and explained his desire to keep things casual. The girl, who works for Emirates airline, spends some time in Kenya, some time in Dubai, and therefore also has limited time. I asked Steve if his wife knew, and he said of course he could not tell her–in fact, he had to go home and be “sweet” to her (have sex) as he was to go the next day to see the girlfriend for several days, and didn’t want suspicion. Based on numerous conversations during cooking, washing, etc. with other Kenyan married women, I told him that the wives were often conscious of the affair, but as long as the husband kept providing for them, it was okay. He agreed, but insisted his wife didn’t know. I asked him why he was taking another woman, and he said that for several confidential reasons, his wife was no longer making him happy. However, as they have children, he does not want to upset his children’s lives, so he won’t divorce his wife. Being a person who pushes for equality, I asked Steve what would happen if the wife found out, and decided to take a boyfriend… this made Steve a bit upset, but he explained that if the wife was to take a boyfriend, she must go with the boyfriend. He then referred to the newly minted Kenyan law, legalizing polygamous marriage (to those who are not Christian, Hindu or entering into a religiously mandated monogamous marriage), asking me if I had ever heard of a polyandrous clause. I hadn’t. That’s because one doesn’t exist. Therefore, while Steve can have girlfriend, that on the off chance might lead to a second marriage, his wife can’t have a boyfriend, because polyandry is illegal.

While totally foreign to me (which he acknowledged), the rational is based on a history and culture of polygamy, and of gender inequality. Women are not equal to men in relationships, and this is demonstrated throughout other sectors. This is why women here (especially in the village) are generally okay if a husband wants a second wife, as long as he is still able to provide some financial assistance to the first wife and her children. I’ve met many young men in this area who swear to only take one wife, as they came from families with absentee fathers, and watched their mothers suffer greatly to provide food and school fees for their children. In contrast, Steve came from a family with three wives, who his successful father cared for. The world has a long history of polygamy, especially when war eliminates a large percentage of a male population. And yet, looking at the modern world powers, very few “first world” countries exhibit large amounts of polygamous marriage. Perhaps when it comes to development of a country, the equalizing of gender is an important step. If Kenya was to follow this rational, and work to equalize gender, men and women would be equal, resulting in a law allowing polyandry (highly unlikely) or the end of polygamy (much more likely). This makes me wonder… does the promotion of equality lead to the decline of “culture” and “tradition”? Can it be argued that “new” culture and tradition form (although, based on the definition of culture and tradition – with the basis being history and long term practice), is it even possible to form “modern culture”? Or does equality lead to a population that works to not have differences, where culture and tradition become obsolete?

With new adventures come new updates! I’m writing to you from Kakamega, Kenya (yes, the place that I left only a mere 3 months ago). Amidst a flurry of washing, and packing, a friend and local business owner asked me if I would consider coming back to help with a social project the company had been struggling to get going. Eco2librium is in the business of reducing carbon emissions through reforestation and low emission stove installation around Kakamega Forest. A couple years ago, an American visited Eco2librium and was inspired by the company’s idea—an ecological change supported through involving the social sector. The stoves that are installed are produced by women’s groups made up of individuals with very low income, education, and options. Almost all of these women have children, but many have lost their husbands due to HIV or other illness, or have absentee husbands who spend a lot of time being drunk on local brew and sleeping with other women. The welfare, nutrition, and education of the children therefore falls to the mothers, who generally don’t have many ways of making money—hence why they join local women’s groups what are aimed at income generating projects.

One incoming generating project is producing low-emission, clay stoves. The women’s groups produce the stoves from local materials, fire them, and then sell the stoves to Eco2librium and other companies doing similar work. Eco2librium sells the stoves (at a very subsidized cost) to local families around the Kakamega Forest area. Before buying these stoves, most families use a 3-stone cooking model—literally 3 large stones placed closely together, with a pot balanced on top. This means that when the families burn wood to cook their food, a lot of heat is lost in the gaps between the stones. The low-emission stoves direct the heat upwards, making cooking faster, and cutting the amount of firewood needed by almost 70%. This allows families to spend less time cooking, and less money or time gathering firewood, and can use that time for other things, like tending the farm, or looking after children.

When Eco2librium first started this project, they bought these liners from one women’s group, called the Volanji Group. As time passed and word spread about this business venture, other women’s groups have come forward wanting to become involved. One big challenge: to have the funds to buy stove molds and build a kiln to fire the stoves. This is what the American who visited found when she visited in 2011, the need for funds. Going back to the US, she managed to raise $10,000 USD to start an initiative of supplying loans to women’s groups so that they can invest in income generating activities. The concept behind the loans is that the women’s groups can borrow the first loan (of ksh100,000- to cover molds and the kiln construction) with no interest, and upon paying back this loan, can borrow again, at a higher amount. The first two loans given are intended to be interest free, with any following loans having some interest attached. The first loan is to be used for stove construction purposes, with future loans having more flexibility in use.

My job is to get this project (which has been dragging along for a year and a half) up and running- to conceptualize, finish drafting and finalize procedure and application forms, work with several groups to get them through the process, and leave a clear procedure behind for Eco2librium staff to follow for groups that are interested in the future. Yes, a big project, but one that is engaging and interesting, and that will hopefully be highly rewarding.

For those of you wondering about the children’s home… no, I haven’t forgotten about the girls! It is currently a school holiday, and I have been able to visit several of them visiting aunties or uncles, and will head to the home tomorrow to see the rest! Since coming back I’ve heard that the John Deere Project I worked on last time I was here (bringing several officials and other staff from South Africa to the children’s home farm to do a project) has actualized, and as of next week, the JD group will be here building two large green houses, where the children’s home staff can grow vegetables, such as tomatoes, for eating and selling! A huge success for Vumilia!

Dehydration is a major threat during hot periods for people with T1, and can result in prolonged high blood sugar and possible DKA!

It’s gotten very hot here in Kenya- January through March is the dry seasons, and the hot sun makes the temperatures sore! If not taking enough fluids, the intense heat can cause dehydration.

A couple weeks ago, I fell into this pit- my blood sugars were high for several days, my insulin didn’t seem like it was working, I was feeling sick. Luckily, in Kenya, you can go to a pharmacy and buy bags of saline, tubes and IV insertion sets. My clinical-officer friend gave me the IV, hooked me up with a liter of intravenous fluid, and within the hour my blood sugars started to come down!

Lesson of the week: water is essential (it makes up the majority of our cells), and we have to remember to respect the fluid balance!

This statement was made by Akinyi, the mother who lives with her 7-year-old son on the compound with me and looks after the area. We were sitting in the kitchen, her in front of the wood-burning cooking stove stirring milk tea, me sitting on the floor that had been smeared with cow dung and clay a few days prior. We sit most days and talk, becoming more frank as our comfort with each other increases. This statement, however, took me by surprise. She explained her reasoning for saying this: in Kenya, ARVs are relatively easy to get, as NGOs and rich Western countries have flooded clinics and hospitals with either free, or very inexpensive forms. But as HIV becomes less of a death threat, and more of a chronic illness, other diseases are starting to be identified as life-threatening… cancer is among them. I saw an article a few weeks back in one of the Kenyan national newspapers about breast cancer’s large impact in Kenya. But I didn’t think much of it, as cancer is a problem most everywhere. But as Akinyi continued to tell me, there isn’t much equipment or drug supply to treat cancer, making it inaccessible to the vast majority of Kenyans, rich or poor. In Kenya, if you have cancer, you go back to your house and lay and rest until you pass… cancer literally means death. I think back over the weeks I’ve been here, and realize I’ve been seeing it, assuming people were getting treatment… most recently, a man with a hugely distended, perfectly spherical stomach, coming out of the general hospital. The longer I live here, and the more I see, I believe more strongly that health care isn’t simply a universal human right, it is a privilege, and one that many don’t have. Universally, human bodies falter, fail and are in need of repair to continue life… and this care isn’t available. How do we lower the cost of health care universally? I read an article recently in the New England Journal of Medicine discussing the cost versus need of HPV vaccination in developing countries… in the US, this cost is around $360, far above what most families in rural Kenya earn in 3 months. And yet, cervical cancer is the second most deadly cancer for women, regardless of country or region.

There are far more health issues in Kenya than cancer and HIV, and it seems that despite the effort put in so far, there is so much still that is totally wrong… structurally, we are flawed. And I feel incredible guilt in having the ability of having access to such a higher level of health care in a mere 26 hours of flying time. It is very different growing up hearing that life isn’t fair, and actually seeing how unfair it is… perhaps this is naivety why should one life have that much more opportunity than another?

Last night, beneath my blanket, under a mosquito net, I tried to sleep… and although it was like every other night since I got my pump in 2002, I was particularly aware that I was connected to it last night… every turn and shift made me alert to the fact that next to me lay a small mechanical box keeping me alive!!

Sitting at the table this morning drinking milk tea (a Kenyan staple), I wonder what caused my hypersensitivity… my pump site wasn’t causing any discomfort, and while I got tangled a little bit, that’s kind of normal when turning over in sleep… and yet, the entire 7 hours of semi-sleep, I consciously knew I was attached. Hmmm, metaphorically, maybe this means I’m having an issue with always having to be attached via cord to a lifeline… and maybe these musings are better for later in the day, once I’ve gotten more caffeine… anyone with a psychoanalysis of this predicament, I am open to your interpretation.

Wow, I can’t believe how remiss I have been about posting since getting to Kenya!! The entire concept of “Kenyan time” is clearly affecting me, seeing as it doesn’t feel possible that it has already been 4 weeks since I arrived in Nairobi. I am now in rural northwestern Kenya, near a town called Kakamega. This experience so far has been amazing—my eyes are open to so many brand new things, I feel that I am learning a lot and my views are changing.

But… as this is a blog on health and diabetes, I probably should not get on my soapbox about all things social and public health… or at least not until I get my update on diabetes done!

So, here we go. Things with my blood sugars have been pretty good considering all the changes- it is much hotter here than I am used to, meaning that I sweat more, so I have to keep focused on rehydrating! I have used Gatorade powder that I brought from the States, and on the couple of days that I have felt very under hydrated, they have helped restore water content and salt (both of which is lost through sweat). The food is also very different here, I eat a lot of maize (similar to corn) and grains, some vegetables, and occasionally fruit. This is a shift from my diet that has a lot of fruit in the US… but I’ve found that even though I am eating more grain here, my blood sugars seem more stable. I attribute this to the lack of processing—most things here are pretty fresh! And in general, I need less insulin for things like bread… the only thing I’m finding that causes me consistent challenges is corn flakes! A surprise to me! Lunch time is usually getheryi, a mixture of maize and beans, with some vegetable (recently, it has been kales!), which ends up being a pretty big bolus for me during the day (around 6-8 units, depending on amount and the day’s activity).

Another surprise was that I had a lot of middle-of-the-night low blood sugars, causing me to change my basal rate (which I haven’t made any significant changes to for about 2 years)… this fixed the problem, and I usually wake up around 100 if my blood sugar is doing well the night before.

Like Eugenie said in her interview, it has been pretty easy to find local snacks to treat low blood sugar, from juice boxes to local candies… so this hasn’t been an issue. Additionally, I was pleasantly surprised to find that certain chemists (pharmacies) in Nairobi carried Humalog in addition to several other types of insulin (several that I had never heard about), so I have a pretty local backup plan in case of any insulin emergency. But for now, the 20 bottles are keeping chilled in my FRIO packs, a product that I will happily recommend to anyone doing any traveling or needing a way to keep insulin cold when on the move!

I think that is all for now, beyond the general encouragement I would like to offer to any yearning travelers… don’t be afraid, having an amazing adventure despite T1 is totally possible with the right preparation. So go, be brave, have adventure, and look forward to learning about the world around you and yourself!

It is my 5th day in Kenya, and my final day in Nairobi—tomorrow, I will head northwest to the town of Kakamega. Spending my first few days in Nairobi with the director’s family has been very helpful in acclimating me to a very new environment and culture. Likewise, being in the capitol city for the first few days in a new country has given me some peace of mind, as it is in Nairobi that I will have the greatest access to extra insulin supplies should I have any issues with what I packed.

From my last post, you know that I was nervous about Kenyan customs having a problem with the amount of needles and other “drug” supplies I was bringing into the country… upon arrival, I was relieved to see that my checked bags looked to be about the same size as they were in the US, and taking the advice of an older friend who has traveled in and out of Kenya many times, I made it through customs just fine by smiling and making light small talk! In fact, the only thing they asked me about was the rectangular shape in one of my checked bags, which was the board game Sorry! After asking me a few questions about this (what is this? – a child’s board game… how much is it worth?—probably 5 American dollars, it is used… used?—yes sir, I used it as I grew up), the security guard nodded, and let me on my way.

Upon arriving at the home I am staying at for my time in Nairobi, I took a minute to myself to check the bags for my supplies, and confirmed that nothing appeared to me missing! Huzzah! Storing my extra supplies of insulin in the fridge, I proceeded to enjoy my time getting to know the director and her family, going around Nairobi, and visiting the Giraffe Home and getting a giraffe kiss!! Wonderful!